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Meta-Analysis
. 2016 Mar;10(3):354-62.
doi: 10.1093/ecco-jcc/jjv196. Epub 2015 Oct 27.

Contrast-enhanced Ultrasound for Detection of Crohn's Disease Activity: Systematic Review and Meta-analysis

Zbigniew Serafin  1 , Marcin Białecki  2 , Agnieszka Białecka  3 , Luca Maria Sconfienza  4 , Maria Kłopocka  5
Affiliations
Meta-Analysis

Contrast-enhanced Ultrasound for Detection of Crohn's Disease Activity: Systematic Review and Meta-analysis

Zbigniew Serafin et al. J Crohns Colitis. 2016 Mar.

Abstract

Background and aims: Reports on imaging of active Crohn's disease (aCD) using contrast-enhanced ultrasound (CEUS) are encouraging. However, the statistical power of most published papers is limited due to the small size of the patient groups included. This study was performed to verify the diagnostic value of CEUS in detecting aCD.

Methods: A systematic literature search was performed by two independent reviewers for articles on the test characteristics of CEUS for the identification of aCD. The quality of the analysed studies was evaluated using a quality assessment tool for diagnostic accuracy studies (QUADAS-2). Pooling was performed using a diagnostic random-effect model and bivariate analysis.

Results: Eight articles were included in the final analysis, with a total of 332 patients. There was no significant publication bias. Significant heterogeneity was found regarding CEUS methodology and sonographic definitions of aCD. In a bivariate analysis, pooled sensitivity was 0.94 (95% CI 0.87-0.97) and pooled specificity was 0.79 (95% CI 0.67-0.88). Spearman correlation statistics presented no significant diagnostic threshold effect (r = 0.12, p > 0.9). Subgroup analysis showed that relative intestine wall enhancement had the highest diagnostic value (area under the curve 94%), while the presence of enhancement and analysis of the slope were less useful (area under the curve 91 and 90%, respectively).

Conclusions: CEUS presents good sensitivity and moderate specificity in the detection of the aCD. Large-scale randomized trials with quantitative evaluation of CEUS images are necessary to promote this technique in clinical practice.

Keywords: CEUS; Crohn’s disease; meta-analysis.

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Figures

Figure 1.
Figure 1.
Flow chart of the literature search.
Figure 2.
Figure 2.
Results of QUADAS-2 quality assessment of original studies.
Figure 3.
Figure 3.
Negative likelihood ratio, positive likelihood ratio and odds radio and their forest plots for the diagnostic value of CEUS in detecting Crohn’s disease activity.
Figure 4.
Figure 4.
Summary receiver operating characteristic plot presenting test performance of CEUS in detecting Crohn’s disease activity.
See this image and copyright information in PMC

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